Early hearing testing of still critically ill neonates.

OBJECTIVE: To use a newly applied hearing screening technique for early measurement in neonatal intensive care unit (NICU) patients to learn more about the high incidence of hearing loss in this population. METHODS: An automated, portable infant hearing screener that measures the auditory brain-stem response at the bedside was used at the NICU of the Hospital Nacional de Niños, San Jose, Costa Rica. Patients were evaluated early, even if they were on a ventilator. The screener tested with a 40-dB hearing level click stimulus to each ear over a bandwidth of 750 to 3000 Hz. RESULTS: During a 15-month period, 92 newborns underwent 226 auditory brain-stem response tests (range, one to six tests; mean, 2 1/2 tests). Before discharge from the NICU or death, each infant was successfully screened. Of 72 infants discharged from the hospital alive, 68 passed bilaterally and four failed bilaterally, a 6% failure rate. Of 20 infants who died, 15 failed bilaterally, a 75% failure rate. Persistent bilateral failure of the test was detectable from each infant's first test and showed an association (chi-square, P<.001) with death. The overall bilateral failure rate was 21%. CONCLUSIONS: Simple bedside auditory brain-stem response screening of all NICU infants was consistently possible regardless of clinical status, the early onset of hearing loss suggests that NICU treatment was not ototoxic and the unexpectedly high overall bilateral test failure rate resulted from the inclusion of patients who would have died untested if conventional testing had been done.

Selective inner hair cell loss in premature infants and cochlea pathological patterns from neonatal intensive care unit autopsies.

BACKGROUND: Deafness and handicapping sensorineural hearing impairment occur frequently in neonatal intensive care unit survivors for unknown reasons. PATIENTS AND METHODS: Hearing was tested early and repeatedly in neonatal intensive care unit patients with an auditory brainstem response (ABR) screener. The temporal bones of 15 nonsurvivors (30 ears) were fixed promptly (average, 5 hours) after death for histological evaluation. RESULTS: Among these patients, 12 failed the ABR screen bilaterally, 1 passed unilaterally, and 2 passed bilaterally. Cochlear histopathologic conditions that could contribute to hearing loss included bilateral selective outer hair cell loss in 2 patients, bilateral selective inner hair cell loss in 3 (all premature), and a combination of both outer and inner hair cell loss in 2. Other hair cell abnormalities were noted; the 2 infants who had passed the ABR screen demonstrated normal histological features. Neuronal counts were normal. CONCLUSIONS: Auditory brainstem response failure among these neonatal intensive care unit infants who died was extremely common in part owing to an unexpected histological alteration, selective inner hair cell loss among premature newborns, that should be detectable uniquely by the ABR testing method. Additional histological patterns suggest more than one cause for neonatal intensive care unit hearing loss. Hair cell loss patterns seem frequently compatible with in utero damage.

[Fibrinogen as independent risk factor for ischemic stroke]. / Fibrinogênio como fator de risco independente de doença vascular cerebral.

We have studied fibrinogen levels (Clauss technique) in atherothrombotic ischemic stroke patients, in order to determine its role as a thrombogenic risk factor. Twenty nine patients (20 men and 9 women) between 25 and 79 years old were studied; they all have had a atherothrombotic stroke. They were classified into two groups according to the result of their carotid doppler ultrasonography: gl-without carotid flow reduction (n = 19) and g2-with carotid flow reduction (n = 10). The fibrinogen mean value was 269 mg/dl in gl and 353 mg/dl in g2. There were 47% of patients in gl and 80% of patients in g2 who presented levels > 300 mg/dl. The proportions of the groups were significantly different (p < 0.05). Considering the epidemiological value of 300 mg/dl, we conclude that the fibrinogen can be an independent risk factor for ischemic atherothrombotic stroke, specially in those whose carotid flow is reduced.

[Lipid changes of fibrinogen and of platelet aggregation induced by etofibrate]. / Modificações lipídicas do fibrinogênio e da agregação plaqutária induzidas pelo etofibrato.

PURPOSE: To evaluate modifications on lipid profile, fibrinogen and platelet aggregation induced by etofibrate. METHODS: Twenty-one adult patients were studied. They all had primary hyperlipidemia and had already been on the AHA step I diet and placebo. Etofibrate (500mg/day) was administered for 60 days in the active phase, when lipid parameters, fibrinogen and platelet aggregation were measured. RESULTS: The % significant reductions were: total cholesterol (-9.50%), LDL-cholesterol (-7.88%), triglycerides (-19.07%), total cholesterol/HDL-cholesterol(-11.90%), LDL-cholesterol/HDL-cholesterol (-10.20%), fibrinogen (-12.79%), platelet aggregation with adrenaline (-24.02%), with ADP 1 mumol (-30.13%), and ADP 3 mumol (-24.51%). CONCLUSION: The beneficial effects of etofibrate were observed not only on the lipid profile but also on the thrombogenic parameters measured by fibrinogen and platelet aggregation.

[Comparison between lovastatin and gemfibrozil in treatment of primary hyperlipidemias]. / Comparação entre a lovastatina e o gemfibrozil no tratamento de hiperlipidemias primárias.

PURPOSE: To compare the effects of lovastatin and gemfibrozil in patients with primary hyperlipidemias. PATIENTS AND METHODS: Forty patients with cholesterolemia over 200 mg/dl and triglyceridemia not higher than 350 mg/dl, excluded secondary causes, were selected. Twenty patients received lovastatin and 20 gemfibrozil. In order to establish the lipid profile, blood samples were taken after 2 months without medication, after 4 weeks of diet and placebo and after 6 and 12 weeks of active treatment. Biochemical profile was determined before and after the treatment with active drug. RESULTS: Thirty nine patients completed the study. Total and LDL-cholesterol were significantly reduced (p less than 0.05) by both drugs but lovastatin had greater effect. Only gemfibrozil reduced triglycerides significantly. Neither drug had significant effects on HDL-cholesterol. The tolerance was satisfactory; only one patient (using gemfibrozil) needed to stop the treatment due to gastrointestinal side effects. The biochemical profile did not present any significant alteration. CONCLUSION: Both drugs produced useful effects on the lipid profile. Lovastatin produced greater reductions of total and LDL-cholesterol, while gemfibrozil was more active reducing triglycerides. Neither drug changed significantly the HDL-cholesterol.

Hydrochlorothiazide abolishes the anti-atherosclerotic effect of quinapril.

1. Antihypertensive treatment has been demonstrated to result in persistent reductions in morbidity and mortality due to stroke. However, the coronary risk attributable to hypertension has been only partially reversed. We hypothesized that diuretics could have unfavourable effects on atherosclerosis. 2. New Zealand rabbits were fed a 0.5% cholesterol-enriched diet for 12 weeks, followed by a 0.1% cholesterol diet for another 12 weeks. During the last 12 week period, 40 animals were randomly assigned to one of four groups: (i) group I was the control group; (ii) group II received hydrochlorothiazide (10 mg/day); (iii) group III received quinapril (30 mg/day); and (iv) group IV was treated with hydrochlorothiazide (10 mg/day) plus quinapril (30 mg/day). 3. The treatments did not affect either the lipid profile or serum electrolytes and oxidative stress. However, endothelium-dependent vasorelaxation in isolated aortic rings was significantly improved with quinapril (group III) treatment (P < 0.001 vs other groups). In addition, therapy with quinapril promoted a significant reduction in atherosclerosis (intima area, intima/media ratio and perimeter of vessel with plaque; P < 0.05 vs other groups), as well as in cholesterol content of the aorta (P < 0.05 vs groups II and IV). 4. In conclusion, hydrochlorothiazide did not modify atherosclerosis and, when added to quinapril treatment, impaired the anti-atherosclerotic effect seen with quinapril alone.

Modificações lipídicas do fibrinogênio e da agregaçäo plaquetária induzidas pelo etofibrato / Actions of etofibrate on lipid profile, fibrinogen and platelet aggregation

Objetivo - avaliar os efeitos do etofibrato sobre variáveis lipídicas, fibrinogênio e agregaçäo plaquetária. Métodos - foram selecionados 21 portadores de hiperlipidemia primária, associada a fatores de risco para doença coronária, após introduçäo de dieta (AHA fase I) e dias, analisando-se as modificaçöes lipídicas induzidas (colesterol total e fraçöes, triglicérides) e efeitos sobre o fibrinogênio e agregaçäo plaquetária. Resultados - foram observadas reduçöes percentuais significantes das variávs: colesterol total (9,50 por cento), LDL-colesterol (-7,88 por cento), triglicérides (19,07 por cento), colesterol total/HDL-colesterol (-11,90 por cento), LDL-colesterol/HDL-colesterol (-19,20 por cento), fibrinogênio (-12, 79 por cento) agregaçäo plaquetária com adrenalina (-24,02 por cento), com ADP 1 ymol (-30,13 por cento), com ADP 3 ymol (-24,51 por cento). Conclusäo - efietos benéficos do etofibrato foram observados näo somente sobre o perfil lipídico mas, também sobre variáveis de trobogenicidae como o fibrinogênio e a agregaçäo plaquetária.